Provider Demographics
NPI:1285724500
Name:USAMEDDAC WURZBURG UNIT 26610
Entity type:Organization
Organization Name:USAMEDDAC WURZBURG UNIT 26610
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:01149931-804-3626
Mailing Address - Street 1:USAMEDDAC WURZBURG HEALTH CLINIC
Mailing Address - Street 2:UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:01149931-804-3626
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WURZBURG HEALTH CLINIC
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:01149931-804-3626
Practice Address - Fax:01149931-804-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862913163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN